CERT Inquiries and Solutions

  1. Do I need to have the beneficiary's authorization to release the information to the CERT contractor?
    No. Medicare patients have already given authorization to release necessary medical information in order to process claims. Therefore, Medicare contractors do not need to obtain a patient's authorization to release medical information.
  2. What do the letters from the CERT look like?
    There are several documentation request letters This link will take you to an external website. that your facility may receive from the CERT contractor. If your facility does not respond to the initial letter within 30 days, CERT contractor will send a second letter. A third letter will be sent out 60 days after the initial letter, and the final letter is sent 75 days after the initial letter.
  3. We are receiving Request for Additional Documentation or Tech Stop letters notifying us that a stop has been placed on the CERT review until we provide additional documentation. Is there a time limit for responding to a Request for Additional Documentation/Tech Stop?
    Yes, the time frame is 15 calendar days from the date of the Request for Additional Documentation letter.
  4. There are some instances where not all the documentation is at one facility, thus making the service seem unreasonable. Do we need to obtain all the information from our outsourced/associated suppliers/providers?
    Yes. When responding to the request from CERT, providers/suppliers must submit all sufficient medical records pertaining to the services provided. Some of the CERT denials are because not enough information was submitted in the original request. Often, the ordering physician's original order, or results from lab tests, conservative treatment history, MRIs, or CT's are the missing documentation.
  5. Does Noridian make reminder calls for the non-responder and Request for Additional Documentation/Tech Stop letters?
    Yes, Noridian makes two reminder phone calls for documentation requests and one follow-up call for Request for Additional Documentation/Tech Stops.
  6. What can providers do if they have lost records due to flooding, etc.?
    Providers may obtain a Disaster Attestation Form from the CERT Provider website This link will take you to an external website.. After validation of the facts, the claim is pulled from the sample and another claim is selected as a replacement.

Last Updated Oct 07, 2016